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FM
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C
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C
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BioPlus Specialty Pharmacy

Account Manager - Payor Relations

Altamonte Springs, FL, United States

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Job details

Experience: 3+ years of experience with Healthcare Plans or Specialty Pharmacy
Posting language: English
Posted: Apr 12, 2022

Original job description

Company Description As one of the largest and most respected specialty pharmacies, BioPlus creates a meaningful difference to our patients, prescribers, payers, and pharmaceutical partners. Our 2 - Hour Patient Acceptance Guarantee gives a quick response to prescribers and patients for critical, time - sensitive treatments. As we continue to grow, we need exceptionally talented, bright, and driven people. If you would like to help us continue to be the innovative leader in our industry, this is your chance to join our team.

Job Description

Position Summary Responsible for providing support in managing payor relations, program implementation, data feeds as contracted, and other contractual requirements. Provide analysis of contracts, facilitate internal company communication concerning payor clients, and manage payor contract requirements in order to maintain compliance and contract obligations.

Essential Functions:

Ensure accurate and timely completion of all assigned and contractual client requirements (reporting, application/contraction completion, presentation, monthly analysis).
Serve as the primary contact for assigned accounts, interacting with client contacts to facilitate problem resolution and promote high client satisfaction
Work directly with internal stakeholders including finance, IT, legal, operations, account management, contract management, sales and others to define requirements and support successful implementation and sales pull through on payor contracts.
Maintain a current request for proposal (RFP) library, coordinate with stakeholders to maintain relevant and accurate information, develop RFP responses as approved by the executive team.
Assist the Director of Contract Management with the business development process of contracting and executing new payor relationships.
Work with other department, sales/account managers, pharmacy, billing, PCC’s and other departments to support company objectives.
Engages targeted payors for contracts to allow pending patient dispensing
Assist Credentialing Specialist as needed to complete enrollment applications/packages (Medicaid, Part D, MCO)
Respond to questions surrounding contracts (reimbursement, benefit design, contracted services)
Collate and create monthly, quarterly, and annual payor reports
Review and analyze weekly shipped, non-admit, and discharge reports
Assist admissions/PA with difficult patient cases
Provide insight of changes within plans to sales, admissions, pharmacy, and billing departments
Provide analysis of growth potential within each plan and a full region
Assist Hemophilia team (reimbursement, plan access, LOA, patient onboarding, etc.)
Obtain Letter of Agreement when required for services (workmen’s comp/medical services)
Announce drug formulary changes at a plan to internal customers
Provide analysis and support for VPs of Managed Care, Sr. Director of Contract Management and the SVP Trade
Manage, review and follow up of pending contracts and provide support for timely completion, update contract files upon contract execution

Other Duties:

Participate and perform other related duties as assigned by Leadership.

Competency:

Strong knowledge of specialty pharmacy contracting, payor, PBM’s and managed care
Must be able to meet time-sensitive deadlines and handle confidential and sensitive information appropriately
Ability to work and lead in a team-oriented, collaborative environment.
Excellent organization skills required and the ability to work on multiple accounts simultaneously.
Maintains compliance with all BioPlus Specialty Pharmacy policies and procedures
Strong organizational skills with the ability to manage multiple work streams and implementation projects simultaneously.
Ability to rapidly adapt and respond to changes in environment and priorities
Demonstrate excellent oral and written communication skills
Strong networking skills
Demonstrate proficiency in the use of MS Office software; which includes Excel, Word and Outlook
Demonstrate the BioPlus C.A.R.T. values
Competence
Accountability
Respect
Trust

Qualifications

Education/Experience Requirements:

Associate or Bachelor’s degree in healthcare related field preferred
3+ years of experience with Healthcare Plans or Specialty Pharmacy

Additional Information BioPlus offers competitive compensation packages including health care, 401(k), growth potential, and a challenging and exciting work environment. BioPlus is an Equal Opportunity Employer

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More about this job

Skills

Communication skills
Regulatory compliance
Reporting
Contract management
Sales
Onboarding
Leadership
Organizational skills
Microsoft Office
Microsoft Excel
Microsoft Word
Microsoft Outlook

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